Comparison of Prognosis and Health‐Related Quality of Life Between Robot‐Assisted Radical Prostatectomy Versus High‐Dose‐Rate Brachytherapy Combined With External Beam Radiation Therapy and Hormone Therapy for High‐Risk Prostate Cancer

ABSTRACT Background We compare the oncological outcomes and health‐related quality of life (HRQOL) in men with high‐risk prostate cancer after robot‐assisted radical prostatectomy (RARP) versus that after high‐dose‐rate brachytherapy + external beam radiotherapy + hormone therapy (hereafter: “HDR+”). Methods We included 233 men who underwent RARP and 179 men who underwent HDR+ for high‐risk prostate cancer at our hospital. We investigated the following oncologic outcomes: time to biochemical recurrence, time to development of castration‐resistant prostate cancer (CRPC), cancer‐specific survival, and overall survival. HRQOL was assessed using SF‐8 and Expanded Prostate Cancer Index Composite (EPIC) at baseline and at 3, 6, 12, and 24 months after treatment. Propensity score matching was performed to adjust the background of the two treatment groups. Results The HDR+ group had a significantly lower rate of biochemical recurrence than the RARP group ( p ≤ 0.01). There were no significant differences between the two groups in the time to CRPC, in cancer‐specific survival, or in overall survival. The two groups had similar HRQOL, according to SF‐8. The urinary domain of EPIC was significantly worse in the RARP group at 3 and 6 months postoperatively than in the HDR+ group ( p ≤ 0.01). Urinary function and urinary incontinence were significantly worse in the RARP group than in the HDR+ group at all time points postoperatively ( p ≤ 0.01), while urinary irritation/obstruction was significantly worse in the HDR+ group at 12 months than in the RARP group ( p ≤ 0.01). Bowel function was similar between the two groups. Conclusions Both RARP and HDR+ were considered to be effective treatments for patients with high‐risk prostate cancer in terms of oncological outcomes. Our RARP group had more postoperative urinary incontinence than our HDR+ group, while the HDR+ group had more frequent urination as a symptom of late genitourinary toxicity than the RARP group.